Portal vein thrombosis natural history, complications and prognosis: Difference between revisions
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{{Portal vein thrombosis}} | {{Portal vein thrombosis}} | ||
{{CMG}}; {{AE}} | {{CMG}}; {{AE}} {{F.K}} | ||
==Overview== | ==Overview== | ||
If left untreated, | If left untreated, patients with portal vein thrombosis may progress to develop portal cavernoma, gastric or [[esophageal varices]]/bleeding, [[hepatic encephalopathy]], [[splenomegaly]], portal biliopathy, and cholangiopathy. Depending on the extent of the model for end-stage liver disease score at the time of diagnosis, the prognosis may vary. However, the prognosis is generally regarded as good. | ||
==Natural History, Complications, and Prognosis== | ==Natural History, Complications, and Prognosis== | ||
===Natural History=== | ===Natural History=== | ||
* | *There is usually subclinical prothrombotic state in about in about 72% of idiopathic portal vein thrombosis. | ||
*If left untreated, patients with portal vein thrombosis may progress to develop portal cavernoma, gastric or [[esophageal varices]]/bleeding, [[hepatic encephalopathy]], [[splenomegaly]], portal biliopathy, and cholangiopathy.<ref name="pmid25941431">{{cite journal |vauthors=Chawla YK, Bodh V |title=Portal vein thrombosis |journal=J Clin Exp Hepatol |volume=5 |issue=1 |pages=22–40 |year=2015 |pmid=25941431 |pmc=4415192 |doi=10.1016/j.jceh.2014.12.008 |url=}}</ref> | |||
*If left untreated, | |||
===Complications=== | ===Complications=== | ||
*Common complications of portal vein thrombosis include:<ref name="pmid26288604">{{cite journal |vauthors=Trebicka J, Strassburg CP |title=Etiology and Complications of Portal Vein Thrombosis |journal=Viszeralmedizin |volume=30 |issue=6 |pages=375–80 |year=2014 |pmid=26288604 |pmc=4513836 |doi=10.1159/000369987 |url=}}</ref><ref name="pmid11159889">{{cite journal |vauthors=Condat B, Pessione F, Hillaire S, Denninger MH, Guillin MC, Poliquin M, Hadengue A, Erlinger S, Valla D |title=Current outcome of portal vein thrombosis in adults: risk and benefit of anticoagulant therapy |journal=Gastroenterology |volume=120 |issue=2 |pages=490–7 |year=2001 |pmid=11159889 |doi= |url=}}</ref><ref name="pmid18814081">{{cite journal |vauthors=Garcia-Pagán JC, Hernández-Guerra M, Bosch J |title=Extrahepatic portal vein thrombosis |journal=Semin. Liver Dis. |volume=28 |issue=3 |pages=282–92 |year=2008 |pmid=18814081 |doi=10.1055/s-0028-1085096 |url=}}</ref><ref name="pmid12774008">{{cite journal |vauthors=Condat B, Vilgrain V, Asselah T, O'Toole D, Rufat P, Zappa M, Moreau R, Valla D |title=Portal cavernoma-associated cholangiopathy: a clinical and MR cholangiography coupled with MR portography imaging study |journal=Hepatology |volume=37 |issue=6 |pages=1302–8 |year=2003 |pmid=12774008 |doi=10.1053/jhep.2003.50232 |url=}}</ref><ref name="pmid17170017">{{cite journal |vauthors=Dhiman RK, Behera A, Chawla YK, Dilawari JB, Suri S |title=Portal hypertensive biliopathy |journal=Gut |volume=56 |issue=7 |pages=1001–8 |year=2007 |pmid=17170017 |pmc=1994341 |doi=10.1136/gut.2006.103606 |url=}}</ref> | *Common complications of portal vein thrombosis include:<ref name="pmid26288604">{{cite journal |vauthors=Trebicka J, Strassburg CP |title=Etiology and Complications of Portal Vein Thrombosis |journal=Viszeralmedizin |volume=30 |issue=6 |pages=375–80 |year=2014 |pmid=26288604 |pmc=4513836 |doi=10.1159/000369987 |url=}}</ref><ref name="pmid11159889">{{cite journal |vauthors=Condat B, Pessione F, Hillaire S, Denninger MH, Guillin MC, Poliquin M, Hadengue A, Erlinger S, Valla D |title=Current outcome of portal vein thrombosis in adults: risk and benefit of anticoagulant therapy |journal=Gastroenterology |volume=120 |issue=2 |pages=490–7 |year=2001 |pmid=11159889 |doi= |url=}}</ref><ref name="pmid18814081">{{cite journal |vauthors=Garcia-Pagán JC, Hernández-Guerra M, Bosch J |title=Extrahepatic portal vein thrombosis |journal=Semin. Liver Dis. |volume=28 |issue=3 |pages=282–92 |year=2008 |pmid=18814081 |doi=10.1055/s-0028-1085096 |url=}}</ref><ref name="pmid12774008">{{cite journal |vauthors=Condat B, Vilgrain V, Asselah T, O'Toole D, Rufat P, Zappa M, Moreau R, Valla D |title=Portal cavernoma-associated cholangiopathy: a clinical and MR cholangiography coupled with MR portography imaging study |journal=Hepatology |volume=37 |issue=6 |pages=1302–8 |year=2003 |pmid=12774008 |doi=10.1053/jhep.2003.50232 |url=}}</ref><ref name="pmid17170017">{{cite journal |vauthors=Dhiman RK, Behera A, Chawla YK, Dilawari JB, Suri S |title=Portal hypertensive biliopathy |journal=Gut |volume=56 |issue=7 |pages=1001–8 |year=2007 |pmid=17170017 |pmc=1994341 |doi=10.1136/gut.2006.103606 |url=}}</ref> | ||
**Portal cavernoma | **Portal [[cavernoma]] | ||
**Gastric or esophageal varices/bleeding | **Gastric or [[esophageal varices]]/bleeding | ||
**Hepatic encephalopathy | **[[Hepatic encephalopathy]] | ||
**Portal biliopathy or cholangiopathy | **Portal biliopathy or cholangiopathy | ||
**Thrombocytopenia | **[[Thrombocytopenia]] | ||
**Splenomegaly | **[[Splenomegaly]] | ||
**[[Ascites]] | |||
**[[Peritonitis]] | |||
**[[Hypoxia]] | |||
**[[Pulmonary artery hypertension]] | |||
**[[Portal hypertensive gastropathy]] | |||
===Prognosis=== | ===Prognosis=== | ||
*The 1 year mortality rate of patients with chronic portal vein thrombosis is approximately 80%-95% and the 3 year mortality rate of patients with chronic portal vein thrombosis is approximately 75%-90%.<ref name="ParikhShah2010">{{cite journal|last1=Parikh|first1=Sameer|last2=Shah|first2=Riddhi|last3=Kapoor|first3=Prashant|title=Portal Vein Thrombosis|journal=The American Journal of Medicine|volume=123|issue=2|year=2010|pages=111–119|issn=00029343|doi=10.1016/j.amjmed.2009.05.023}}</ref><ref name="pmid17697371">{{cite journal |vauthors=Sogaard KK, Astrup LB, Vilstrup H, Gronbaek H |title=Portal vein thrombosis; risk factors, clinical presentation and treatment |journal=BMC Gastroenterol |volume=7 |issue= |pages=34 |year=2007 |pmid=17697371 |pmc=1976099 |doi=10.1186/1471-230X-7-34 |url=}}</ref><ref name="pmid17958760">{{cite journal |vauthors=Amitrano L, Guardascione MA, Scaglione M, Pezzullo L, Sangiuliano N, Armellino MF, Manguso F, Margaglione M, Ames PR, Iannaccone L, Grandone E, Romano L, Balzano A |title=Prognostic factors in noncirrhotic patients with splanchnic vein thromboses |journal=Am. J. Gastroenterol. |volume=102 |issue=11 |pages=2464–70 |year=2007 |pmid=17958760 |doi=10.1111/j.1572-0241.2007.01477.x |url=}}</ref> | *The 1 year [[mortality rate]] of patients with [[chronic]] portal vein thrombosis is approximately 80%-95% and the 3 year [[mortality rate]] of patients with chronic portal vein thrombosis is approximately 75%-90%.<ref name="ParikhShah2010">{{cite journal|last1=Parikh|first1=Sameer|last2=Shah|first2=Riddhi|last3=Kapoor|first3=Prashant|title=Portal Vein Thrombosis|journal=The American Journal of Medicine|volume=123|issue=2|year=2010|pages=111–119|issn=00029343|doi=10.1016/j.amjmed.2009.05.023}}</ref><ref name="pmid17697371">{{cite journal |vauthors=Sogaard KK, Astrup LB, Vilstrup H, Gronbaek H |title=Portal vein thrombosis; risk factors, clinical presentation and treatment |journal=BMC Gastroenterol |volume=7 |issue= |pages=34 |year=2007 |pmid=17697371 |pmc=1976099 |doi=10.1186/1471-230X-7-34 |url=}}</ref><ref name="pmid17958760">{{cite journal |vauthors=Amitrano L, Guardascione MA, Scaglione M, Pezzullo L, Sangiuliano N, Armellino MF, Manguso F, Margaglione M, Ames PR, Iannaccone L, Grandone E, Romano L, Balzano A |title=Prognostic factors in noncirrhotic patients with splanchnic vein thromboses |journal=Am. J. Gastroenterol. |volume=102 |issue=11 |pages=2464–70 |year=2007 |pmid=17958760 |doi=10.1111/j.1572-0241.2007.01477.x |url=}}</ref> | ||
*Mortality in patients with [[cancer]] or [[cirrhosis]] in one year is 26% and those without cancer or cirrhosis is 8%.<ref name="pmid11159889">{{cite journal |vauthors=Condat B, Pessione F, Hillaire S, Denninger MH, Guillin MC, Poliquin M, Hadengue A, Erlinger S, Valla D |title=Current outcome of portal vein thrombosis in adults: risk and benefit of anticoagulant therapy |journal=Gastroenterology |volume=120 |issue=2 |pages=490–7 |year=2001 |pmid=11159889 |doi= |url=}}</ref> | |||
*Depending on the extent of the model for end-stage liver disease score at the time of diagnosis, the prognosis may vary. However, the prognosis is generally regarded as good.<ref name="pmid11600478">{{cite journal |vauthors=Janssen HL, Wijnhoud A, Haagsma EB, van Uum SH, van Nieuwkerk CM, Adang RP, Chamuleau RA, van Hattum J, Vleggaar FP, Hansen BE, Rosendaal FR, van Hoek B |title=Extrahepatic portal vein thrombosis: aetiology and determinants of survival |journal=Gut |volume=49 |issue=5 |pages=720–4 |year=2001 |pmid=11600478 |pmc=1728504 |doi= |url=}}</ref> | *Depending on the extent of the model for end-stage liver disease score at the time of diagnosis, the prognosis may vary. However, the prognosis is generally regarded as good.<ref name="pmid11600478">{{cite journal |vauthors=Janssen HL, Wijnhoud A, Haagsma EB, van Uum SH, van Nieuwkerk CM, Adang RP, Chamuleau RA, van Hattum J, Vleggaar FP, Hansen BE, Rosendaal FR, van Hoek B |title=Extrahepatic portal vein thrombosis: aetiology and determinants of survival |journal=Gut |volume=49 |issue=5 |pages=720–4 |year=2001 |pmid=11600478 |pmc=1728504 |doi= |url=}}</ref> | ||
*Morbidity and mortality is associated with following factors:<ref name="ParikhShah2010">{{cite journal|last1=Parikh|first1=Sameer|last2=Shah|first2=Riddhi|last3=Kapoor|first3=Prashant|title=Portal Vein Thrombosis|journal=The American Journal of Medicine|volume=123|issue=2|year=2010|pages=111–119|issn=00029343|doi=10.1016/j.amjmed.2009.05.023}}</ref> | *[[Morbidity]] and [[mortality]] is associated with following factors:<ref name="ParikhShah2010">{{cite journal|last1=Parikh|first1=Sameer|last2=Shah|first2=Riddhi|last3=Kapoor|first3=Prashant|title=Portal Vein Thrombosis|journal=The American Journal of Medicine|volume=123|issue=2|year=2010|pages=111–119|issn=00029343|doi=10.1016/j.amjmed.2009.05.023}}</ref> | ||
**Increasing age | **Increasing age | ||
**Recurrent thrombosis | **Recurrent [[thrombosis]] | ||
**Portal cholangiopathy | **Portal cholangiopathy | ||
**Progression of the underlying myeloproliferative disease or its transformation into acute leukemia | **Progression of the underlying [[myeloproliferative disease]] or its transformation into [[acute leukemia]] | ||
==References== | ==References== |
Latest revision as of 14:31, 29 December 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Farima Kahe M.D. [2]
Overview
If left untreated, patients with portal vein thrombosis may progress to develop portal cavernoma, gastric or esophageal varices/bleeding, hepatic encephalopathy, splenomegaly, portal biliopathy, and cholangiopathy. Depending on the extent of the model for end-stage liver disease score at the time of diagnosis, the prognosis may vary. However, the prognosis is generally regarded as good.
Natural History, Complications, and Prognosis
Natural History
- There is usually subclinical prothrombotic state in about in about 72% of idiopathic portal vein thrombosis.
- If left untreated, patients with portal vein thrombosis may progress to develop portal cavernoma, gastric or esophageal varices/bleeding, hepatic encephalopathy, splenomegaly, portal biliopathy, and cholangiopathy.[1]
Complications
- Common complications of portal vein thrombosis include:[2][3][4][5][6]
- Portal cavernoma
- Gastric or esophageal varices/bleeding
- Hepatic encephalopathy
- Portal biliopathy or cholangiopathy
- Thrombocytopenia
- Splenomegaly
- Ascites
- Peritonitis
- Hypoxia
- Pulmonary artery hypertension
- Portal hypertensive gastropathy
Prognosis
- The 1 year mortality rate of patients with chronic portal vein thrombosis is approximately 80%-95% and the 3 year mortality rate of patients with chronic portal vein thrombosis is approximately 75%-90%.[7][8][9]
- Mortality in patients with cancer or cirrhosis in one year is 26% and those without cancer or cirrhosis is 8%.[3]
- Depending on the extent of the model for end-stage liver disease score at the time of diagnosis, the prognosis may vary. However, the prognosis is generally regarded as good.[10]
- Morbidity and mortality is associated with following factors:[7]
- Increasing age
- Recurrent thrombosis
- Portal cholangiopathy
- Progression of the underlying myeloproliferative disease or its transformation into acute leukemia
References
- ↑ Chawla YK, Bodh V (2015). "Portal vein thrombosis". J Clin Exp Hepatol. 5 (1): 22–40. doi:10.1016/j.jceh.2014.12.008. PMC 4415192. PMID 25941431.
- ↑ Trebicka J, Strassburg CP (2014). "Etiology and Complications of Portal Vein Thrombosis". Viszeralmedizin. 30 (6): 375–80. doi:10.1159/000369987. PMC 4513836. PMID 26288604.
- ↑ 3.0 3.1 Condat B, Pessione F, Hillaire S, Denninger MH, Guillin MC, Poliquin M, Hadengue A, Erlinger S, Valla D (2001). "Current outcome of portal vein thrombosis in adults: risk and benefit of anticoagulant therapy". Gastroenterology. 120 (2): 490–7. PMID 11159889.
- ↑ Garcia-Pagán JC, Hernández-Guerra M, Bosch J (2008). "Extrahepatic portal vein thrombosis". Semin. Liver Dis. 28 (3): 282–92. doi:10.1055/s-0028-1085096. PMID 18814081.
- ↑ Condat B, Vilgrain V, Asselah T, O'Toole D, Rufat P, Zappa M, Moreau R, Valla D (2003). "Portal cavernoma-associated cholangiopathy: a clinical and MR cholangiography coupled with MR portography imaging study". Hepatology. 37 (6): 1302–8. doi:10.1053/jhep.2003.50232. PMID 12774008.
- ↑ Dhiman RK, Behera A, Chawla YK, Dilawari JB, Suri S (2007). "Portal hypertensive biliopathy". Gut. 56 (7): 1001–8. doi:10.1136/gut.2006.103606. PMC 1994341. PMID 17170017.
- ↑ 7.0 7.1 Parikh, Sameer; Shah, Riddhi; Kapoor, Prashant (2010). "Portal Vein Thrombosis". The American Journal of Medicine. 123 (2): 111–119. doi:10.1016/j.amjmed.2009.05.023. ISSN 0002-9343.
- ↑ Sogaard KK, Astrup LB, Vilstrup H, Gronbaek H (2007). "Portal vein thrombosis; risk factors, clinical presentation and treatment". BMC Gastroenterol. 7: 34. doi:10.1186/1471-230X-7-34. PMC 1976099. PMID 17697371.
- ↑ Amitrano L, Guardascione MA, Scaglione M, Pezzullo L, Sangiuliano N, Armellino MF, Manguso F, Margaglione M, Ames PR, Iannaccone L, Grandone E, Romano L, Balzano A (2007). "Prognostic factors in noncirrhotic patients with splanchnic vein thromboses". Am. J. Gastroenterol. 102 (11): 2464–70. doi:10.1111/j.1572-0241.2007.01477.x. PMID 17958760.
- ↑ Janssen HL, Wijnhoud A, Haagsma EB, van Uum SH, van Nieuwkerk CM, Adang RP, Chamuleau RA, van Hattum J, Vleggaar FP, Hansen BE, Rosendaal FR, van Hoek B (2001). "Extrahepatic portal vein thrombosis: aetiology and determinants of survival". Gut. 49 (5): 720–4. PMC 1728504. PMID 11600478.